The statistics in SA are frightening - 900 Aids-related deaths a day; 5,5m infected with HIV. For every person who goes on antiretroviral therapy nearly four others become infected.
Not a day goes by without an economically active person falling victim to the perverse, deadly disease. But as World Aids Day on December 1 is a chilling reminder of how HIV/Aids is starting to wipe out the world's workforce, it's not only about the devastation anymore - it's about what can be done to beat this insidious disease and prevent further loss of life.
"HIV, Aids and TB remain national priorities requiring urgent action by all sectors of society," government spokesperson Themba Maseko says.
WHAT IT MEANS
 Despite having the biggest treatment programme, SA has fallen far behind
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Globally billions of dollars are being pumped into research to find a wonder drug, but the disease that attacks the body's immune system has, for the past 25 years, eluded even medical scientists. Thousands of volunteers have died in the name of science, in the quest to find a single vaccine to protect against Aids. But it could be decades before a vaccine that could contain the global epidemic, which affects about 33m people and kills between 2,4m and 3,3m each year mainly in sub-Saharan Africa, is produced.
Barbara Hogan
In SA, HIV denialism by ousted president Thabo Mbeki and his quixotic health minister Manto Tshabalala-Msimang has already resulted in at least 330 000 preventable deaths and 35 000 babies born with HIV. According to a recent study by the Harvard School of Public Health, between 2000 and 2005, Mbeki's government stalled on delivering a national antiretroviral programme and ensuring babies were born free of HIV. There's now empirical evidence that political obstruction has blocked access to life-saving drugs.
Civil society, the opposition and business have been shouting for many years for government to be more proactive in tackling the pandemic. Then, finally last year, this push culminated in the birth of the ambitious National Strategic Aids Plan 2007-2011, one of the world's most progressive policies on the deadly disease. SA now has the biggest treatment programme in the world with 575 000 people on antiretroviral drugs.
But what's disappointing is that the lack of political support and leadership from the former president and health minister has left the plan - hailed by the UN - all but dead in the woods. Under Tshabalala-Msimang's watch, SA's burden of the HIV/Aids crisis reached alarming proportions. Policy implementation still remains patchy and access to Aids drugs and services is a post-code lottery.
As much as SA has shed its dissident stance, the slow implementation of the plan dampens the combative spirit that emerged after the international Aids conference in Toronto in 2006 and Boksburg last year. "We've made huge gains. We have all the right policies in place now, but implementing them is painful," says Rebecca Hodes, head of policy, communication & research at the Treatment Action Campaign (TAC).
"Take Brazil, as an example. It has about 95% coverage of antiretroviral treatment (ART), yet our coverage is only about 20% because of the disease burden and late rollout of ART arising from political bungling."
Rwanda is another good example. Coming out of a genocide, it has far weaker health structures than SA. "Yet, they've shamed us," says Hodes. "SA has more resources, skilled doctors, nurses and infrastructure than Rwanda, but their penetration of ART is about 50%-60%."
There are many reasons why the National Strategic Aids Plan has not been working according to plan. Among them are lack of capacity. "Because of the sheer volumes and high rates of infections, we need more doctors and nurses. We also need to decentralise and give nurses more power," charges Hodes. "There are too many bottlenecks because of the huge brain drain and we are not getting any new skills into the pool of specialists trained in the administration of HIV treatment."
The major challenge is the large numbers of infected people who need treatment immediately, which the provinces can't initiate because of costs and lack of skills. "For example, each new person who goes on treatment needs their own support person, baseline blood work, among others," says Hodes.
In the US, there are 33 regiments of treatment. In SA, there are two regiments on the public health system, and they are expensive. "Regiment 1A, for example, costs about R2 400/month per patient, excluding blood work. And, because most people in SA are co-infected with TB and HIV, it's not cut and dry... which is why we need skilled workers," says Hodes.
But the Aids scientific community is hoping that under the caretaker watch of new health minister Barbara Hogan HIV/Aids will get the priority it deserves. But she will need unqualified support from all levels of government.
"ARVs will never be enough to stop this time bomb," says Aids scientist Dr Glenda Gray who is among the SA team that is working on a miracle vaccine. "But the political climate in which we work is very important. The previous minister was very hostile. It was always a fight. When you work in an environment where people don't believe HIV causes Aids, it makes efforts to tackle HIV/Aids all the more difficult. Hopefully it will become easier to work in HIV now than it was in the past."
The cards have definitely shifted, it seems, with Hogan driving home the message: "I'm sorry I even have to state it - we all know HIV causes Aids."
She wants to reinvigorate and capacitate the SA National Aids Council (Sanac) to oversee its mandate in implementing the National Strategic Aids Plan. For example, she says the extent to which pregnant women use government services for preventing mother-to-child transmission of HIV can be improved within six months. She is pushing for campaigns by Sanac and its partners to improve the low take-up in some districts.
Government says programmes are already in full swing to implement the national strategic plan. These include measures to ensure that all mothers with HIV remain healthy, all babies are born free of HIV, increasing access to antiretrovirals (ARVs), promoting healthy lifestyles through reducing sexual partners and using condoms, knowing your status, and ensuring that children from households affected by HIV and Aids are protected and supported.
And government has allocated an extra R300m to the HIV/Aids conditional grants this financial year for the increased cost of the new AZT-nevirapine regimen for preventing mother-to-child transmission of HIV. The budget for HIV/Aids conditional grants has been revised up R932m over the medium term, taking the total to R12,4bn.
But it's not enough to make a dent on the increasing rate of infection. The scientific community says the flawed health system needs an overhaul. They believe denialism and bad science have not yet been rooted out of government.
Take, for example, the KwaZulu Natal health MEC Peggy Nkonyeni. She encourages charlatans touting HIV potions while attacking dedicated HIV doctors.
The Free State is another example where government bureaucracy is holding back rollout. The province is experiencing critical shortages of ARVs because of lack of funding and health-care workers have been instructed to stop putting new patients on treatment with the exception of pregnant women.
Experts say Hogan must form a strong team to fight the paralysing bureaucracy that has exacerbated government's slow delivery on HIV/Aids. Says Dr Francois Venter, president of the HIV Clinicians Society of Southern Africa: "The poorest people are dying. The Western Cape and Gauteng got going early on. But people in provinces such as Mpumalanga, Limpopo and KwaZulu Natal are suffering. And these are only the quantifiable deaths. If the number of people dying from TB or poor hospital services are included, the figures would be triple."
Mark Heywood, head of the Aids Law Project, says the country now has an unparalleled opportunity to make a marked difference. "We do not want to overlook what has been done, but we all need to unite behind the National Strategic Plan and the new health minister. We are behind every target and that is where our focus should be."
